NEWEST INNOVATIONS IN REFERENCE BASED PRICING. Ed Day, HST Cindy Hom, MedWatch
|
|
- Patricia Shields
- 6 years ago
- Views:
Transcription
1 NEWEST INNOVATIONS IN REFERENCE BASED PRICING Ed Day, HST Cindy Hom, MedWatch
2 THE WAY WE DO THE HEALTHCARE HEALTHCARE HST HST All RightsResered Resered Confidential
3 Company Oeriew Who We Are What We Do HST is at the forefront of proiding referenced-based pricing (RBP) to its client to help reduce healthcare claims cost since We proide pricing solutions that reduce healthcare costs for payers and consumers by introducing price accountability through transparency. Our Goal Is to reolutionize the way we do healthcare by bending the cost cure downward with alue based payments. Headquartered Irine, CA HST HST All RightsResered Resered Confidential
4 What is Reference-based Pricing (RBP) Definition preailing price for medical serices. RBP is a reimbursement that uses objectie databases such as Medicare and cost information to determine the Types Of RBP Medicare factor equialent RBP Health Plan Cost plus Procedure specific Consumer drien Quality Frequency of serices as a leading indicator Readmission rates outcomes Top hospital ealuation criteria High risk procedures and diagnosis HST HST All RightsResered Resered Confidential
5 Hae You Heard? Why Medical Bills Are Killing Us Time Magazine, February 2013 $60,000 for $74 ultrasound $21,000 for a heartburn bill 62% of household bankruptcies due to medical expenses SEIU Fair Healthcare Pricing Act of 2014: SEIU, February 2014 Reimburse hospitals at 25% aboe cost Stanford billed $8.6 billion with Expenses of $2.1 billion CalPERS Reference price knees and hips: CalPERS, June 2013 Saed an estimated $3.1 million Expanding for other outpatient procedures HST HST All RightsResered Resered Confidential
6 Want To See RBP? The Numbers Billed Charges: 6.89 x MAP Cost/Medicare Data PPO Discount: 58% RBP Payment: $19,162 Saings Below PPO: $17,801 Additional Saings: 20% HST HST All RightsResered Resered Confidential
7 RBP Plan Case Study Client Profile and Situation 230 Employee multi-state self-funded group Based on 12 months of paid claims Utilized a BUCA PPO THE No benchmarking HEALTHCARE data or R&C (UCR) language HST Inolement Improed reimbursements using reference pricing; Medicare at 150% Turnkey solution from pricing databases, plan docs and stop loss underwriting Client Benefits Reduced claims cost, stop loss premium and PPO fees Claims: $2,896,377 Stop Loss: $791,677 PPO Fees: $15.67 (PEPM) Results PPO RBP Annual Saings $2,519,840 $574,018 $10.25 $376,537 (13% saings) $217,659 (28% saings) $14,959 (35% saings) Enhanced cost plus benchmarking to ensure pricing accountability and alue payments Presered Plan Assets Established a sustainable reimbursement model SUSTAINABILITY Oerall Saings of: $609,155 or 16.3% of Total Cost HST HST All RightsResered Resered Confidential
8 Typical Renewal Inflation: Fully-Insured of 12% s. Self-Funded of 8% s. RBP tracking Medicare at 1%. INCEPTION tt Trend Oer Time YEAR-1 YEAR-2 YEAR-3 YEAR-4 Fully-Insured 400, , , , ,407 Self-Funded 400, , , , ,195 RBP 400, , , , ,241 FULLY- INSURED SELF - FUNDED RBP 650, , , , , , , ,000 INCEPTION YEAR-1 YEAR-2 YEAR-3 YEAR HST HST All RightsResered Resered Confidential
9 RBP Plan Comparison Client Profile and Situation 1400 Employee self-funded group Based on 12 months of paid claims Preious endors fees on percentage of billed charges of 12% for all claims HST Inolement Reduced endor fees by 90% Fee Comparison Percentage of Billed Charges Per Employee Per Month Billed Charges $13,417,794 $13,417,794 Saings $9,602,708 $9,602,708 Fees $1,610,135 $163,570 Saed an additional $1,446,565 Implemented a PEPM of $7.50 (including prepricing) Experienced 2% Outlier claims paid at 14% with fee cap applied Client Benefits Reduced endor fees Decreased Stop Loss premium $1,800,000 $1,600,000 $1,400,000 $1,200,000 $1,000,000 $800,000 $600,000 $400,000 $200,000 $0 SUSTAINABILITY Annual Fees % Of Billed Charges PEPM Achieed lowest claims cost HST HST All RightsResered Resered Confidential
10 The HST Solution Pricing proided prior to care deliery such as knees and hips RBP Prepricing Naigator HST s unique, collaboratie model integrates pricing into the pre-authorization process setting the pricing of medical serices before they are deliered. Well-suited for electie admissions and high-frequency serices Unique approach is collaboratie and proider-friendly Benefits Deliers expected reimbursements prior to rendering care Mitigates member balance billing Accurate price estimates based on procedures and diagnosis Timely turnaround and integration with the pre-authorization process Transparent upfront communication with proiders HST HST All RightsResered Resered Confidential
11
12
13 MedWatch s Nurse Naigator A National Solution offering members freedom to select proiders of their choice using a unique Reference-Based Pricing strategy powered by HST Integrated RBP health plan that deliers an expected reimbursement prior to rendering care through precertification RBP health plan that integrates medical management through the precertification process and proides an estimated reimbursement rate prior to admission Open access to choose facilities Full transparency with reimbursements tied to Medicare or cost information Additional saings on stop loss premiums Collaboratie, proider-oriented approach Robust patient adocacy program handling member inquiries and proider outreach and re-direction Proides member/patient communication and customer serice Supports a PCP Network
14 Our Approach Payer Transparency Cost up Medicare Geo Specific Prompt pay Collaboration Proiders Accountability Proider reimbursements Network Calibration Accountable care - (P4P) Value based care Empower Comparison shopping Informed Buying Quality Outcomes Mobile Consumer HST HST All RightsResered Resered Confidential
15 Benefits of RBP Transparency Accountability RBP reduces the following: Claims cost Stop loss premiums Network access fees Employee plan cost RBP is a cost-up reimbursement that applies Medicare plus factors to ensure fair & reasonable proider payments; Sustainability Predictability Value RBP s fix fee model proides sustainable long term alue driing to the lowest claims & plan cost; Ties the Plans medical price index to Medicare inflation factors of 1%-2% ersus 5%-15% for alternate funded plans; RBP bends the cost cure downward with alue based payments. THE WAY WE DO HEALTHCARE HST HST All RightsResered Resered Confidential
16 Patient Adocacy Center (PAC) Member Protects And Guides Draft Member Letters Proider Explains Reimbursement Reiews Plan Language Inquiries Handled By PAC Negotiate Agreement Proider Communications Letter Communications HST HST All RightsResered Resered Confidential
17 Find What s Right For You RBP Negotiations THE HEALTHCARE Out-of-Network Claims Wrap Network Claims Pre-serice PPO Claims RBP Health Plan Hospital PPO replacement Turnkey RBP Solution Patient Adocacy Center Outlier Negotiations Serices RBP Analytics RBP Payment Impact Analysis RBP Claims Analysis Network comparison Consumer App Compare pricing by procedure Find a Proider/Facility View Member Info HST HST All RightsResered Resered Confidential
18 Discussion Q & A What do you see as the potential opportunity? What serice(s) best meet your needs? Conduct a demonstration RBP Claims Analysis, seeing is belieing? T HST HST All RightsResered Resered Confidential
HALF YEAR RESULTS H September 16th, 2014
HALF YEAR RESULTS H1 2014 September 16th, 2014 Today s Presenters Fabio Cannaale Francesco Signoretti Gaspar Santonja Founder and Chairman CEO CFO p.2 Key Highlights Continuous growing olumes in a more
More informationProblems with Current Health Plans
Problems with Current Health Plans Poor Integration, Coordination and Collaboration - Current plans offer limited coordination between the health plan, Providers, and the Members, as well as limited mobile
More informationEmployer-Led Innovation for Healthcare Delivery and Payment Reform
Employer-Led Innovation for Healthcare Delivery and Payment Reform National Accountable Care Congress November 12, 2014 1 Overview of CalPERS Nearly 1.4 million members More than 1,200 employers State
More informationBest Practices. for Treasury, Agency Debt, and Agency Mortgage- Backed Securities Markets. Revised May 2013
Reised May 2013 Best Practices for Treasury, Agency Debt, and Agency Mortgage- Backed Securities Markets This document is aailable on the Treasury Market Practices Group website, www.newyorkfed.org/tmpg.
More informationSouth Orange County Community College District DISTRICT-WIDE PLANNING AND DECISION MAKING MANUAL
South Orange County Community College District DISTRICT-WIDE PLANNING AND DECISION MAKING MANUAL 2015 2020 Table of Contents 3 Foreword 5 From the Chancellor 6 Planning and Decision Making 7 Introduction
More informationREFERENCED BASED PRICING: THE GOOD THE BAD AND THE UGLY
REFERENCED BASED PRICING: THE GOOD THE BAD AND THE UGLY Best Practices and Cautionary Tales of Reference Based Pricing for TPAs and Employers SIIA 2014 Annual Meeting Phoenix Arizona Monday Oct 6 th 3:15
More informationWorkshop on section 10AA and 35AD. 5 May 2016
Workshop on section 10AA and 35AD 5 May 2016 Section 10AA Oeriew of the section Tax holiday for export profits units set up in Special Economic Zone ( SEZ ) Commencement should be after 1 April 2006 Other
More informationReference Based Pricing Leveling the Playing Field in Healthcare Cost and Quality
Reference Based Pricing Leveling the Playing Field in Healthcare Cost and Quality What s Top of Mind? As employers look forward to 2017 and beyond, they continue to focus on some key issues: 1) Controlling
More information6 Degrees Health Reference Based Pricing Processes and Standard Procedures
6 Degrees Health Reference Based Pricing Processes and Standard Procedures 6 Degrees Health Background 6 Degrees Health was founded in May of 2012, with a focus on providing transparent solutions backed
More informationReference-Based Pricing Is Being Redefined
Reference-Based Pricing Is Being Redefined by Kenneth B. Berry MAGAZINE Reproduced with permission from Benefits Magazine, Volume 52, No. 10, October 2015, pages 26-31, published by the International Foundation
More informationFACILITY MAINTENANCE POLICY
Public Works and Goernment Serices Canada Real Property Serices FACILITY MAINTENANCE POLICY August, 1997 Version 1.0 Public Works and Goernment Serices Canada Real Property Serices FACILITY MAINTENANCE
More informationControlling Hospital Charges for Self-funded Plans
Controlling Hospital Charges for Self-funded Plans Phillip C. Giles, CEBS Vice President Sales & Marketing QBE North America Accident & Health As more employers self-fund their employee healthcare coverage,
More information10/17/2014 Risk-Based Payment Methodologies A National Perspective Art Jones, MD. AccountableCareInstitute.com
10/17/2014 Risk-Based Payment Methodologies A National Perspective Art Jones, MD FQHCs Bridge the Gap in Care Bridge Built and Maintained by FFS Dollars 2 CMMI View of FFS Medicine 3 Accountability High
More informationIND AS 102: SHARE BASED PAYMENT. - CA Premal H Gandhi
IND AS 102: SHARE BASED PAYMENT - CA Premal H Gandhi Objectie & Scope: Objectie: Specify the financial reporting by an entity when it undertakes a share based payment transaction. Scope: This standard
More informationMedical Self-Funding Macro Trends
Medical Self-Funding Macro Trends Big picture economic trends impacting the future of self-funded medical plans. Phillip C. Giles, CEBS Vice President, Sales and Marketing Originally published in Captive
More informationProviders Contracting Directly With Employers
Providers Contracting Directly With Employers NOVEMBER 14, 2018 1 The Current Model 2 Direct-to-Employer (DTE) Health Plan Aligned Incentives Gain Share Direct Relationship At The Table Integrated Data
More informationSelf-Funding and Reference-Based Pricing for Smaller Employers
Self-Funding and Reference-Based Pricing for Smaller Employers Self-Funded Health Plan Designs and Stop-Loss Insurance for Small to Mid-Size Businesses 1 About Starmark Since 1985, Starmark has served
More informationControlling Medical Costs in Self-Funded Employer Benefit Plans
Controlling Medical Costs in Self-Funded Employer Benefit Plans May 2017 Rick Franklin CLU, RHU, REBC CEO Frates Benefit Administrators Employers that offer health benefits to their employees through self-funded
More informationReference Pricing and Bundled Payments
Reference Pricing and Bundled Payments A Match to Change Markets François de Brantes, MS, MBA Executive Director HCI3 Suzanne Delbanco, Ph.D Executive Director Catalyst for Payment Reform Andréa Caballero
More informationPLAN MANAGEMENT ADVISORY GROUP March 29, 2016
PLAN MANAGEMENT ADVISORY GROUP March 29, 2016 WELCOME AND AGENDA REVIEW BRENT BARNHART, CHAIR PLAN MANAGEMENT ADVISORY GROUP 1 AGENDA AGENDA Plan Management and Delivery System Reform Advisory Group Meeting
More informationPROVIDER SERVICES Section IV Provider Services
Section IV Provider Services Provider Services 98 NaviNet www.navinet.net Using NaviNet reduces the time spent on paperwork and allows you to focus on more important tasks patient care. NaviNet is a one-stop
More informationFirst Quarter FINANCIAL UPDATE. 3rd Quarter. November
First Quarter FINANCIAL UPDATE 3rd Quarter Noember 5 2015 Disclaimer All statements in this presentation other than historical facts are forward looking statements that inole risks and uncertainties which
More informationHealth Care Cost Transparency in Minnesota
Health Care Cost Transparency in Minnesota Julie Sonier, President MN Community Measurement October 25, 2018 1 MN Community Measurement: Who We Are and What We Do Multi-stakeholder collaborative Activities
More informationAdmitting Privileges: The right granted to a doctor to admit patients to a particular hospital.
Glossary of Health Care Terms Adapted from the Health Insurance Resource Center Admitting Privileges: The right granted to a doctor to admit patients to a particular hospital. Benefit: Amount payable by
More informationThe Insolvency and Bankruptcy Code, 2016
MAY 2016 SPECIAL EDITION STRICTLY FOR PRIVATE CIRCULATION The Insolency and Bankruptcy Code, 2016 Inter alia is a legal newsletter published each quarter by AZB & Partners for a select list of clients
More informationTraining Documentation
Training Documentation Substance Abuse Rehab Facilities 2017 Health care benefit programs issued or administered by Capital BlueCross and/or its subsidiaries, Capital Advantage Insurance Company, Capital
More informationRequest for Proposal Provision of Coach Services
Request for Proposal Proision of Coach Serices Date of Issue: 7 th March, 2014 Cricket World Cup 2015 Ltd Leel 2, 220 Albert Road South Melbourne Vic 3205 Australia Tel: +61 3 9946 6100 Fax: +61 3 9686
More informationConsumer Price Transparency Examples State and National Websites
Consumer Price Transparency Examples State and National Websites State Consumer Health Information and Policy Advisory Council Meeting March 24, 2016 Health Transparency Websites What do consumers want
More informationHealth Information Technology and Management
Health Information Technology and Management CHAPTER 9 Healthcare Coding and Reimbursement Pretest (True/False) CPT-4 codes are used to bill for disease and illness. Medicare Part B provides medical insurance
More informationTHE ATTORNEY-CLIENT PRIVILEGE
ATTORNEY-CLIENT PRIVILEGE AND WORK PRODUCT DOCTRINE: ISSUES FOR ENVIRONMENTAL CONSULTANTS, COUNSEL, AND CLIENTS Presented by Daid B. Weinstein, Esq. I. THE ATTORNEY-CLIENT PRIVILEGE A. What is it? 1) A
More informationPPO and Alternate PPO Plans
PPO and Alternate PPO Plans AGENDA 1. Introduction 2. Review of Current PPO 3. Alternate PPO Differences 4. Plan Costs and Premiums 5. What do I Need To Do? 6. Questions? 7. HRA High Deductible Plan (if
More informationAetna s value based payment models aim to pay for value delivered, not services rendered
Aetna s value based payment models aim to pay for value delivered, not services rendered Aetna currently has 22% of spend running through contracts with a value based component. Value Based Contracting
More informationPRICE TRANSPARENCY Frequently Asked Questions
PRICE TRANSPARENCY Frequently Asked Questions Introduction Price transparency is one of the most confusing topics in today s healthcare world. Healthcare consumers are becoming more engaged and asking
More informationThe Rebirth of Healthcare. essential benefits and services designed specifically to strengthen any health share program.
The Rebirth of Healthcare essential benefits and serices designed specifically to strengthen any health share program. SHA Plan Highlights of the SHA Plans coerage (no deductible) for Care Co-pay Program
More informationExcellus BlueCross BlueShield Provider Relations Fall Seminar
Excellus BlueCross BlueShield Provider Relations Fall Seminar Agenda Product Updates Safety Net Clear Coverage Authorization Tool Website Updates EDI Updates Clinical Editing BlueCard Medicare Updates
More informationINFORMATION ABOUT YOUR OXFORD COVERAGE
OXFORD HEALTH PLANS (CT), INC. INFORMATION ABOUT YOUR OXFORD COVERAGE PART I. REIMBURSEMENT Overview of Provider Reimbursement Methodologies Generally, Oxford pays Network Providers on a fee-for-service
More informationCommon Managed Care Terms & Definitions
Contact Us: Email: info@emedbiz.com Phone: 561-430-2090 Fax: 561-430-2091 Website: www.emedbiz.com Common Managed Care Terms & Definitions Balance billing: The practice of billing a patient for the amount
More informationJOINT TASK FORCE ON HEALTH CARE COST REVIEW (Senate Bill 419)
May 11 th, 2018 JOINT TASK FORCE ON HEALTH CARE COST REVIEW (Senate Bill 419) 1 AGENDA 8:30-8:35 AM Welcome and Opening Remarks 8:35-9:30 AM Multi-stakeholder Approaches to Address Total Cost of Care 9:35-9:50
More informationPayment Mechanisms. In this section Usual, Customary and Reasonable payment 8.1
In this section Page Usual, Customary and Reasonable payment 8.1! How UCR works 8.1! How to obtain a usual fee profile 8.1 uses specially designed fee structure 8.1 Fee schedule program payment 8.2 Social
More informationTransition Disclosures Template
215 215 1 Directly issued qualifying CET1 capital instruments plus any related share premium 16,378 (11) 2 Retained earnings 39,464 (19) 3 Disclosed reseres 233 4 Directly issued capital subject to phase
More informationUnderstanding Health Care Reform. July 24, 2013 Presented by: Camry Blaising, RHU, REBC
Understanding Health Care Reform July 24, 2013 Presented by: Camry Blaising, RHU, REBC Welcome One-hour webinar Technical questions 800-263-6317 Participants are muted Use Question/Chat feature to submit
More informationINQUIRIES AND RESPONSES
March 27, 2015 Reference Request for Proposals #800100-03132015 to provide Administrative Services Only (ASO) for Self Funded Medical Plans for the State of Louisiana, Office of Group Benefits which is
More informationCHCS. Technical Assistance. Tool. Implementing the Medicaid Primary Care Rate. Increase: A Roadmap for States. Center for Health Care Strategies, Inc.
CHCS Center for Health Care Strategies, Inc. Implementing the Medicaid Primary Care Rate Increase: A Roadmap for States Technical Assistance Tool N OVEMBER 2011 T he Affordable Care Act s (ACA) expansion
More informationHealth Service Board Rates and Benefits Committee Meeting
Health Service Board Rates and Benefits Committee Meeting Blue Shield Medical Group ACO Review April 10, 2014 Prepared by Aon Hewitt Health and Benefits Contents History ACO Overview Evaluation Framework
More informationManaging HIPAA Privacy in a Value-based Environment
Managing HIPAA Privacy in a Value-based Environment Margret Amatayakul, MBA, RHIA, CHPS, CPHIT, CPEHR, CPHIE, FHIMSS President, Margret\A Consulting, LLC An independent consulting firm focusing on optimizing
More informationWorking Draft: Health Care Entities Revenue Recognition Implementation Issue. Financial Reporting Center Revenue Recognition
October 2, 2017 Financial Reporting Center Revenue Recognition Working Draft: Health Care Entities Revenue Recognition Implementation Issue Issue #8-9 Risk Sharing Arrangements Expected Overall Level of
More informationBiography. CHRISTOPHER MONROE Senior Vice President, Employee Benefits
CHRISTOPHER MONROE Senior Vice President, Employee Benefits Biography LOKESH NIGAM Senior Vice President, Employee Benefits Biography Alternative Reimbursement Strategies Chris is a true veteran within
More informationLA12-23 STATE OF NEVADA. Audit Report. Public Employees Benefits Program Legislative Auditor Carson City, Nevada
LA12-23 STATE OF NEVADA Audit Report Public Employees Benefits Program 2012 Legislative Auditor Carson City, Nevada Audit Highlights Highlights of Legislative Auditor report on the Public Employees Benefits
More informationFIVE WAYS TO HANDLE HIGH-DEDUCTIBLE PATIENTS IN YOUR MEDICAL PRACTICE
Billing & Reimbursement Revenue Cycle Management FIVE WAYS TO HANDLE HIGH-DEDUCTIBLE PATIENTS IN YOUR MEDICAL PRACTICE Billing and Reimbursement for Physician Offices, Ambulatory Surgery Centers and Hospitals
More informationChart 4.1: Percentage of Hospitals with Negative Total and Operating Margins,
Chart 4.1: Percentage of Hospitals with Negative Total and Operating Margins, 1995 2014 45% 40% 35% Negative Operating Margin 30% 25% 20% 15% Negative Total Margin 10% 5% 0% 95 96 97 98 99 00 01 02 03
More informationStrategic Benefits Consulting Services Contract. Administrative Committee Cheryl D. Orr, Vice President of Human Capital August 14, 2018
Strategic Benefits Consulting Services Contract Administrative Committee Cheryl D. Orr, Vice President of Human Capital August 14, 2018 0 DART s Vision for Healthcare Benefits To create a sustainable benefits
More informationMGMA National MGMA18 The Annual Conference September, 2018 Attendee Form
MGMA National MGMA18 The Annual Conference September, 2018 Attendee Form Title CEU Code CEUs Specialty MGMA18 The Annual Conference-PRE102 Designing and Building Processes for Value-based Healthcare 5
More informationSources of Health Insurance Coverage in California
Sources of Health Insurance Coverage in California Source: California HealthCare Foundation. SNAPSHOT California s Individual and Small Group Markets on the Eve of Reform, 2011. 1 Vision and Mission The
More informationIndividual Insurance
Health Insurance Health Insurance against loss by illness or bodily injury. Health Insurance provides coverage for medicine, visits to the doctor or emergency room, hospital stays and other medical expenses.
More informationH&J Corporate Services (Cayman) Ltd.
H&J Corporate Serices (Cayman) Ltd. P.O. Box 866, Anderson Square Building Grand Cayman, KY1-1103, Cayman Islands Tel: +1 (345) 949-7555 Fax: +1 (345) 949-8492 E-mail: cayman@higgsjohnson.com www.hjcorporate.com
More informationDepartment: ADMINISTRATION
Department: ADMINISTRATION Policy/Procedure: Full Charity Care and Discount Partial Charity Care Policies PURPOSE Torrance Memorial Medical Center (TMMC) is a non-profit organization which provides hospital
More informationGonzales Healthcare Systems Policy
Gonzales Healthcare Systems Policy Subject: Financial Policy and Healthcare Transparency Purpose: To provide affordable and quality healthcare to our community. Therefore, it is essential that we establish
More informationBlue Shield of California Bundled Payments in the Commercial Market: Results and Applications for Self-Funded Employers
Blue Shield of California Bundled Payments in the Commercial Market: Results and Applications for Self-Funded Employers Presented by Scott Leggett Global 1 April 10, 2018 OVERVIEW 1. Better Models Facilitate
More informationHealthcare Value Purchasing: Perspectives from Employers, Facilities and Consumers
Healthcare Value Purchasing: Perspectives from Employers, Facilities and Consumers Montana Chamber of Commerce Healthcare Forum November 29-30, 2016 Shane Wolverton SVP CORPORATE DEVELOPMENT, QUANTROS
More informationfor Employer Groups LIVE LIFE ASSURED
for Employer Groups LIVE LIFE ASSURED 1 Live life assured Together, creating better health and better health care consumers Successfully providing excellent health benefits costeffectively requires a partner
More informationAFFORDABILITY REVIEW. Mysteries of the Medical Loss Ratio
AFFORDABILITY REVIEW Mysteries of the Medical Loss Ratio NANCY DJORDJEVIC DIRECTOR, HEALTHCARE ANALYTICS APRIL 2016 WHO IS GORMAN HEALTH GROUP? Gorman Health Group is the leading solutions and consulting
More informationGilsbar 360 Alliance PROVIDER MANUAL. Gilsbar.
Gilsbar 360 Alliance PROVIDER MANUAL Gilsbar www.gilsbar360alliance.com Dear Provider: Gilsbar is building a PPO network that gives providers and employers the opportunity to truly work together. We ve
More informationHospital Consolidation: The Good, the Bad, and the Backlash
Hospital Consolidation: The Good, the Bad, and the Backlash James C. Robinson Leonard D. Schaeffer Professor of Health Economics Director, Berkeley Center for Health Technology University of California,
More informationAs more employers self-fund their employee healthcare coverage, exploration of risk. Controlling Hospital Charges for Self-Funded Plans
Controlling Hospital Charges for Self-Funded Plans Written by Phillip C. Giles, CEBS, QBE North America As more employers self-fund their employee healthcare coverage, exploration of risk reduction and
More informationFirst Quarter FINANCIAL UPDATE. 4th Quarter. February 25, 2016
First Quarter FINANCIAL UPDATE 4th Quarter February 25, 2016 Disclaimer All statements in this presentation other than historical facts are forward-looking statements that inole risks and uncertainties
More informationInsight to Value-Based Care and A Joint Venture Case Study. Whitney Courser SVP, Sales and Marketing
Insight to Value-Based Care and A Joint Venture Case Study Whitney Courser SVP, Sales and Marketing WCourser@nuehealth.com Meet NueHealth 22-year-old, privately held, nationally trusted healthcare partner
More informationVIRGINIA ACTS OF ASSEMBLY SESSION
VIRGINIA ACTS OF ASSEMBLY -- 2016 SESSION CHAPTER 279 An Act to amend and reenact 2.2-4006, 65.2-605, 65.2-605.1, and 65.2-714 of the Code of Virginia; to amend the Code of Virginia by adding sections
More informationThe FedEx Problem (Working Paper)
The FedEx Problem (Working Paper) Amos Fiat Kira Goldner Anna R. Karlin Elias Koutsoupias June 6, 216 Remember that Time is Money Abstract Benjamin Franklin in Adice to a Young Tradesman (1748) Consider
More informationFINAL CLOSEOUT REPORT
K:\IAC\AGreer\SHARE\6901-LGA Task Orders\To_008 Armenia LGA \Products\Baseline Study\06901-008_Closeout.Rpt.doc FINAL CLOSEOUT REPORT Prepared for Prepared by Mr. Samuel L. Coxson Chief of Party The Urban
More informationHIE Sustainability: MHIN s Strategy ehi Connecting Communities Learning Forum. Jay C. McCutcheon April 10, 2006
HIE Sustainability: MHIN s Strategy ehi Connecting Communities Learning Forum Jay C. McCutcheon April 10, 2006 Topics Sustainability Definitions Critical Success Factors? Health Information Exchange Product
More informationThe Road to Value. Aric R. Sharp, MHA, CMPE, FACHE Vice President Accountable Care UnityPoint Health February 3, 2017
The Road to Value Aric R. Sharp, MHA, CMPE, FACHE Vice President Accountable Care UnityPoint Health February 3, 2017 1,500 Physicians UnityPoint Clinic 17 hospitals + 15 rural network hospitals 35,000
More informationServicing Out-of-Area Blue Members
Servicing Out-of-Area Blue Members BlueCross BlueShield of Western New York BlueCard 101 May 31, 2011 A presentation of the Blue Cross and Blue Shield Association. All rights reserved. Servicing Out-of-Area
More informationREPORT OF THE COUNCIL ON MEDICAL SERVICE. (J. Leonard Lichtenfeld, MD, Chair)
REPORT OF THE COUNCIL ON MEDICAL SERVICE CMS Report -A-0 Subject: Presented by: Referred to: Appropriate Hospital Charges David O. Barbe, MD, Chair Reference Committee G (J. Leonard Lichtenfeld, MD, Chair)
More informationCompanion Property & Casualty whose parent company is Blue Cross & Blue Shield of South Carolina was established in 1984.
Companion Property & Casualty whose parent company is Blue Cross & Blue Shield of South Carolina was established in 1984. Headquartered in Columbia, S.C., Companion Property & Casualty Insurance Group
More informationGulf Coast and LA HFMA Payer Summit Value-based contracts same healthcare business?
Gulf Coast and LA HFMA Payer Summit Value-based contracts same healthcare business? Richard R. Vath, MD FMOLHS SVP/Chief Clinical Transformation Officer President Health Leaders Network and Medicare ACO
More informationTHE UNITED REPUBLIC OF TANZANIA MINISTRY OF FINANCE
THE UNITED REPUBLIC OF TANZANIA MINISTRY OF FINANCE GOVERNMENT PROCUREMENT SERVICES AGENCY (GPSA) ANNUAL PERFORMANCE REPORT JULY 2011 JUNE 2012 SEPTEMBER, 2012 0 Page No. TABLE OF CONTENT.... i 1.0 Part
More informationJefferies Healthcare Conference
Jefferies Healthcare Conference June 7, 2017 Disclaimer Certain statements in this presentation and other oral or written statements made by the Company from time to time are may constitute forward-looking
More informationThe Health Insurance Market in Virginia. Maureen Dempsey, MD, MSc, ACC, FAAP Anthem Blue Cross and Blue Shield June 8, 2017
The Health Insurance Market in Virginia Maureen Dempsey, MD, MSc, ACC, FAAP Anthem Blue Cross and Blue Shield June 8, 2017 Anthem Inc. at a Glance Broad geographic footprint and customer base ` BCBS plans
More information2018 Crossroads Systems is a registered trademark of Crossroads Systems, Inc. All other trademarks are the property of their respectie owners. www.capitalplusfin.com Capital Plus Financial Business Oeriew
More informationOptum. Actuarial Toolbox Proven, sophisticated and market-leading actuarial models for health plans and benefits consultants
Optum Actuarial Toolbox Proven, sophisticated and market-leading actuarial models for health plans and benefits consultants In recent years, the health care landscape has shifted tremendously, prompting
More informationServicing Out-of-Area Blue Members
Servicing Out-of-Area Blue Members BlueShield of Northeastern New York BlueCard 101 May 31, 2011 Servicing Out-of-Area Members Overview BlueCard Program Blue Products Member ID Cards Verifying Eligibility
More informationIn This Issue (click to jump):
May 7, 2014 In This Issue (click to jump): Analysis of Trends in Health Spending 2013 2014 Spotlight on Medicare Advantage Enrollment Oncology Drug Trend Report S&P Predicts Shift from Job-Based Coverage
More information9/23/2016. Our Services. Transitioning from Fee-for-Service to Value-based Reimbursement. Key Trends and Strategies for Rural Health Providers
Transitioning from Fee-for-Service to Value-based Reimbursement Key Trends and Strategies for Rural Health Providers Paul MacLellan, CEO >> Health care consulting company >> Wholly owned subsidiary of
More informationThe Use of Technology to Promote Voluntary Savings. Kenya s Experience
A Dynamic and Secure Retirement Benefits Sector The Use of Technology to Promote Voluntary Saings Kenya s Experience Nzomo Mutuku Chief Executie Office Retirement Benefits Authority October 4, 2018 Mexico
More informationPreferred Equity Investments in Real Estate Joint Ventures (How to Structure and how they differ From Mezzanine Debt)
Preferred Equity Inestments in Real Estate Joint Ventures (How to Structure and how they differ From Mezzanine Debt) Date: March 1, 2017 Mark S. Fawer Benjamin R. Weber Part I Preferred Equity s. Regular
More information1. Name of Applicant: Address:
APPLICATION for: HIPAA Protector and MEDEFENSE PLUS Claims Made Basis. Underwritten by Underwriters at Lloyd s, London The insurer agrees to use all information provided in this Application solely in connection
More informationShort-Run Cost Minimization and Capacity Utilization of Regional Public Hospitals in South Korea
Modern Economy, 205, 6, 2-29 Published Online anuary 205 in SciRes. http://www.scirp.org/ournal/me http://dx.doi.org/0.4236/me.205.6003 Short-Run Cost Minimization and Capacity Utilization of Regional
More informationA n n u a l R e p o r t Tacoma Public Utilities
A n n u a l R e p o r t 2 0 0 7 Tacoma Public Utilities Balance Tacoma Public Utilities will proide competitie, enironmentally responsible electric, water and rail serices through teamwork, technology
More informationRegional Patient Management Subject Transition of Care Coverage Policy California Amendment for HMO Plans
California Amendment to Policy 600-01 Effective Date: 1/16/2007 Regional Patient Management Subject Transition of Care Coverage Policy California Amendment for HMO Plans Originating Dept. West Region Patient
More informationReinsurance Section News
Article from: Reinsurance Section News May 2006 Issue 57 MANAGED CARE UPDATE by Mark Troutman [Portions of this article were reprinted with permission from Contingencies magazine] Introduction This article
More informationTHE FAST AND THE FURIOUS REVENUE CYCLE (A.K.A.) THE REVENUE CYCLE OF THE FUTURE
THE FAST AND THE FURIOUS REVENUE CYCLE - 3.0 (A.K.A.) THE REVENUE CYCLE OF THE FUTURE INDUSTRY ANALYSIS 82% of people say price is the most important factor when making a healthcare purchasing decision*
More informationImproving your ASC s performance in 2018
Improving your ASC s performance in 2018 The ASC guide to major trends that will impact your practice Marilyn Denegre Rumbin, JD MBA Director, Payer & Reimbursement Strategy February 2018 1 Welcome Marilyn
More informationHealthcare Facilities $3.1 Billion
Timothy Fitzgerald, CFA, FHFMA Vice President, Treasury Management 1 Geisinger Health System An Integrated Health Services Organization Physicians & Providers $1.1 Billion ~1,300 Physicians Healthcare
More informationThe Utah Health Exchange Ten Lessons Learned from the Utah Experience Ten Presented by Speaker David Clark Utah House of Representatives
The Utah Health Exchange Ten Lessons Learned from the Utah Experience Presented by Speaker David Clark Utah House of Representatives Ten Lessons Learned 1. Support and Cooperation Within and Across State
More informationACCEPTING ASSIGNMENT 1a
ACCEPTING ASSIGNMENT 1a WHEN A PHYSIAN AGREES TO TREAT MEDICAID PATIENTS ALSO AGREES TO ACCEPT THE ESTABLISHED MEDICAID PAYMENT FOR COVERED SERVICES. 1b ADVANCE BENEFICIARY NOTICE - ABN 2a FORM GIVEN TO
More informationPayment Reform in Support of Population Health Management
Payment Reform in Support of Population Health Management Aligning Forces for Quality Employers - Providers Summit October 25, 2011 Charles Chodroff, MD, MBA, FACP Senior Vice President, Chief Clinical
More informationMedicare Home Health Prospective Payment System
Medicare Home Health Prospective Payment System Payment Rule Brief Proposed Rule Program Year: CY 2014 Overview, Resources, and Comment Submission On July 3, 2013, the Centers for Medicare and Medicaid
More informationThe Greenlight Retirement Program. Minutes of the 12 th Governance Committee Meeting Held on Wednesday December 3, :30 a.m.
Minutes of the 12 th Goernance Committee Meeting Held on Wednesday December 3, 2008 8:30 a.m. TBC Offices Committee: Rob Tamblyn Andy Loscher Matthew Loscher Moe Mailloux The Benefits Company Inc. The
More informationThe Directors have pleasure in presenting their Report and Audited Accounts for the year ended March 31, 2013.
DIRECTORS REPORT The Directors hae pleasure in presenting their Report and Audited Accounts for the year ended March 31, 2013. 1. FINANCIAL RESULTS 2012-2013 in Lakhs 2011-2012 in Lakhs Gross Profit 8,957.25
More informationValuation of Alternative Payment Models
Valuation of Alternative Payment Models No portion of this white paper may be used or duplicated by any person or entity for any purpose without the express written permission of PYA. I. Introduction:
More information